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Foundations II and III > Foundations Exam 3 > Flashcards

Foundations Exam 3 Flashcards

1
Q

Influenza strain type associated with pandemics?

A

Influenza type A

(Type A subtypes:
Hemagglutinins H1, H2, H3
Neuraminidases N1, N2)

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2
Q

Incubation period, transmission, and infectious period - Influenza

A

incubation 2-3 days
transmission is via respiratory droplets/direct contact

pt infectious usually a day before sxs start and will last up to a week

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3
Q

Name general sxs of Flu

A 
Fever
Aches (myalgias) 
Chills ( cough - non-productive)
Tiredness 
Sudden onset

HA, ocular sxs, sore throat

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4
Q

How is Influenza virus testing performed?

Testing options?

A

Nasopharyngeal swabs

  • RAT - rapid antigen test, results in <15 mins, not a perfect test
  • Culture, result in 3-10 days
  • RT-PCR - more accurate, but $$, test time 1-8 hrs
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5
Q

High risk groups that Flu Rx treatment is indicated for..

A 
Extremes of ages
Chronic illnesses (cardiac, pulm, renal, DM) 
Immunosuppression 
Pregnancy/post partum (2wks)
Children <19yo on chronic ASA therapy 
Native Americans
Morbidly obese (BMI>40)
Residents in nursing homes
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6
Q

WHEN should Influenza treatment be initiated?

A

First 24-48hrs

Rx may take ~1-3 days off course and severity of sxs

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7
Q

Antiviral Flu medication options

A

Neuraminidase Inhibitors:

  • Oseltamivir (Tamiflu) most common
  • Zanamivir (Relenza)
  • Peramivir (Rapivab) IV med only
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8
Q

ADEs of Oseltamivir (Tamiflu)

A

n/v 10% most common side effect

in peds, possible agitation, hallucinations, SI (should discuss w parents)

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9
Q

ADEs of Zanamivir (Relenza)

A

Bronchospasm - shouldn’t give to asthmatic pts or those w airway compromise

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10
Q

Complications of Influenza

A 
PNA**
Sinusitis 
Otitis Media 
Myositis/Rhabdomyolysis 
CNS involvement 
Cardiac complications
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11
Q

Flu prevention- who gets vaccinated?

A

everyone >6 months of age

annually ~Oct becomes available

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12
Q

Peds pt (6 months - 8yrs) first season of Flu vaccination- schedule ?

A

2 doses, > 4 weeks apart

1st dose primes their immune system- 2nd dose at or after 4 wk mark, okay for it to be different vaccine

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13
Q

Flu vaccine considerations for adults 65+

A

-higher dose vaccine
(believed elderly have harder time mounting immune response so high dose given)

-adjuvanted seasonal vaccine for adults 65+

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14
Q

Acute bronchitis clinical presentation

A 
Cough >5 days (~1-3 weeks)
\+/- productive 
Usually afebrile
chest wall tenderness 
Wheezing 
Mild dyspnea
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15
Q

Acute bronchitis etiology

A

VIRAL - most common

(even if pt presents with purulent sputum - could just be viral)

Bacterial - pathogens: mycoplasma, c pneumoniae, bordetella pertussis* (only one that should be given Abx tx)

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16
Q

Acute bronchitis PE findings

A

Wheezing
Rhonchi (clears with coughing)
Negative for rales and signs of consolidation

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17
Q

Incubation and contagious time for Pertussis

A

Incubation 7-17 days

Contagious for 2 wks after onset of mild cough (during catarrhal stage)

18
Q

Stages of Pertussis

A

Catarrhal 1-2 wks
(malaise, rhinorrhea, mild cough, milder fever)

Paroxysmal lasts 2-3 months
(paroxysmal cough - whooping cough, +/- post-tussive syncope or emesis)

Covalescent 1-2 wks
(gradual reduction in freq and severity of cough)

19
Q

1st line Tx for Pertussis

A

Macrolides
*Azithromycin 500mg day 1, 250mg day 2-5

Clarithromycin 500mg BID x 7 days

Erythromycin 500mg QID x 7 days

TMP-SMX 160-800mg BID x 7 days

20
Q

When should pregnant women receive Tdap?

A

b/w 27-36 weeks gestation, or immediately postpartum

all infants - Dtap
11-18yo Tdap booster
All adults single Tdap dose
Pregnant women - with each pregnancy

21
Q

How is PNA transmitted?

A
  • Aspiration from oropharynx
  • Inhalation of contaminated droplets
  • Hematogenous (blood) spread
  • Extension from infected pleural or mediastinal space

(don’t catch PNA from someone- might get their URI - but generally PNA occurs b/c of aspiration of organisms)

22
Q

PNA- pathogen and classic presentation

S pneumoniae

A

sudden onset of chills
rust colored sputum

most common of CAP 2/3 cases

23
Q

PNA- pathogen and classic presentation

M pneumoniae

A
  • historically children and adolescents
  • may be asymptomatic or mild
  • CXR - reticulonodular pattern/patchy areas of consolidation
  • Bullae on TM
24
Q

PNA- pathogen and classic presentation

Legionella

A 
GI disorders (watery diarrhea) 
Confusion or encephalopathy 
outbreaks usu from contaminated water sources
25
Q

PNA- pathogen and classic presentation

MRSA

A
  • cavitary infiltrate or necrosis
  • gross hemoptysis
  • rapidly increasing pleural effusions
26
Q

PNA- pathogen and classic presentation

Klebsiella pneumoniae

A
  • comorbidities usu ETOH abuse, DM, severe COPD

- “currant jelly” sputum (thick, mucoid, blood tinged)

27
Q

What are the atypical PNA pathogens?

A

Mycoplasma pneumoniae
Chlamydophilia pneumoniae
Legionella
C psittaci

atypical a historical term, does not mean uncommon - means unresponsive to beta lactams

28
Q

PNA severity index vs

CURB-65

A

index scores to assess whether pt should be treated inpatient or outpatient

PSI - pts > 50yo, w pre-existing conditions and PE abnormalities then stratified on add’l risk factors

CURB 65 - shorter list, pts >65yo

Confusion 
Urea  >7 or BUN >20 (modified version omits)
RR >30breath/mins
BP (SBP <90, DBP <60)
65 - age +

Score 1-2 consider hosp
Score 3-4 urgent hosp +/- ICU

29
Q

CAP Tx outpatient

A

Macrolide or Doxycycline

if risk factors for macrolide resistance or Abx last 3 months

Respiratory fluoroquinolone

or

Beta lactam (high dose Amoxicillin or Augmentin) PLUS macrolide

duration Abx at least 5 days

30
Q

CAP inpatient (non-ICU) Tx

A

Respiratory fluoroquinolone

or

Beta lactam PLUS macrolide

31
Q

CAP ICU inpatient Tx

A

anti-pneumococcal beta-lactam PLUS azithromycin
or

anti-pneumococcal beta-lactam PLUS
a respiratory fluoroquinolone

If PCN allergic: respiratory fluoroquinolone PLUS aztreonam

32
Q

CAP ICU for pseudomonas risk Tx

A

Antipneumococcal, antipseudomonal beta lactam (Cefipime) PLUS either ciprofloxacin or levofloxacin

or

above beta lactam PLUS aminoglycoside PLUS azithromycin (or respiratory fluoroquinolone)

FULL duration 14 day treatment (14-21 days)**

33
Q

CAP ICI Tx for MRSA

A

If MRSA risk:

Add vancomycin or linezolid

34
Q

Duration of Tx for HAP, VAP PNA

A

duration of Tx 14-21 days
if pt responds to initial tx may limit to 7 days

**if Pseudomonas aeruginosa needs to be full duration 14 days minimum

35
Q

Top 3 most common causes of ARDS?

A 
#1 Diffuse PNA 
#2 Sepsis 
#3 Aspiration
36
Q

What is the Berlin definition?

A

All 4 criteria must be met to Dx ARSD

  1. acute onset w/in 1 wk of known clinical insult
  2. bilateral pulmonary infiltrates
  3. respiratory failure not explained by HF or volume overload
  4. mod-severe O2 impairment (ABGs <300mmHg)
37
Q

Spontaneous pneumothorax, clinical presentation, 1st line diagnostics, and treatment ?

A

Usu tall, thin, young men 20-40yo, smokers

Dyspnea, pleuritic CP unilateral and sharp

1st line CXR (best in lateral decubitus view) and CT chest, U/S if emergent at bedside

Tx 100% O2

Small pneumothorax - observe
Large - needle aspiration
Unstable- chest tube

38
Q

Describe a tension pneumothorax

A

medical emergency, 1-2% of primary spontaneous pneumothorax

pt looks really sick! distended neck veins, hypotension, tracheal deviation, worsening dyspnea

CXR mediastinal shift and tracheal deviation contralateral side, flattening or inversion diaphragm ispsilateral side

pt needs chest tube

39
Q

Cause and treatment of secondary spontaneous pneumothorax?

A

occurs as complication of underlying lung dz

more severe than PSP

pts should be hospitalized, most will req chest tube

40
Q

P-HTN

Group 1, etiology

A

Pulmonary arterial hypertension (PAH)
secondary to various disorders..

idiopathic 
portal HTN
Drugs/toxins (appetite suppressants, SSRIs) 
HIV
Schistosomiasis 
CT d/o 
congenital heart dz
41
Q

P-HTN

Group 2, etiology

A

Pulmonary venous hypertension secondary to left heart disease

42
Q

P-HTN

Group 3 etiology

A

1 COPD

secondary to lung disease or hypoxemia

ILD
OSA
high altitudes

Foundations II and III (10 decks)

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